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HeartSmart^(TM):A New Method of Assessing Hydration in Neurosurgical Patients

Surgical Science 2012年第11期3卷 546-553页

作者： Kenneth James Warring-Davies John Martin Bland The Intensive Care Unit Bradford Royal InfirmaryBradfordUK Department of Health Sciences University of YorkYorkUK

Background: Maintenance of normal fluid homeostasis is challenging in neurosurgical patients. Consequently, we studied hydration assessment in neurosurgical intensive care patients. Methods: Pulmonary artery catheter thermodilution (PACTD) is the conventional method for measuring cardiac index (CI) and mean pulmonary artery occlusion (MPAOP) or wedge pressure (MPWP). We compared values from this technique with those derived from continuous cardiac dynamic monitoring (CCDM)-HeartSmart?, a new, less invasive, software-based technique. Over 4 years, we undertook an audit of 101 paired sets of data from 21 patients with sub-arachnoid hemorrhage who had pulmonary artery flotation catheters inserted as part of their treatment. Measured values of CI and MPWP were obtained retrospectively from patients’ charts and compared with values calculated using CCDM-HeartSmart? software. Results: Using the Bland-Altman method for comparing two measurement techniques, there was good agreement between measured and calculated MPWP (mean of differences –1.81, SD 3.97, SE 0.39, 95% CI –2.59 to 2.04 l/min/m2;two-sided p 2). This indicates that, when estimating CI and MPWP in critically ill neurosurgical patients, CCDM-HeartSmart? provides values close to those generated using PACTD. Conclusions: The CCDM-HeartSmart? could prove invaluable for optimizing response to fluid replacement and for guiding cardiovascular support in neurosurgical patients. This new, simple technology may help to facilitate routine adoption of perioperative optimization of blood flow using early goal-directed therapy.

关键词： Cardiac Index CCDM-HeartSmart^(█) Hydration Intensive Care Neurosurgical physiological formulae

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